Not Sick Enough

“Can I ask you something? Would you ever consider going inpatient?” My therapist implored me, her eyes heavy with concern. Truthfully I had been spacing out until that moment, but the term “inpatient” pulled me out of my head quickly. “No way. I’m not sick enough for that.”

This just about sums up the endless cycle between myself and various family members, friends, dietitians and therapists for longer than I would like to admit. They approached the topic of a higher level of care- I brushed off the concern, laughed even, and told them I was not nearly sick enough. And they subsequentially found themselves speaking directly to my eating disorder and not me.

If you can relate, if you ever find yourself thinking “I’m not sick enough” take comfort in the fact that you are not alone in this thought. I can honestly say that I have never met anyone who has suffered from an eating disorder, including myself (see above) that has not had this thought at one point or another. But next time you find yourself thinking this, remember: this thought itself suggests that you are, in fact, “sick enough,” because this is an unhealthy thought to have. People who are well do not tend to wish to be ill.

According to the DSM-5, the most telling diagnostic factor for an eating disorder is a negative impact on social, emotional or physical functioning. This updated diagnostic classification system takes into account that an eating disorder will present itself in a unique way- a specific constellation of symptoms, behaviors, emotions, and thoughts that cause distress and dysfunction in different arenas of one’s life. Hence there is no actual operational definition for “sick enough.” It is an ED thought and one that stems directly back to the biological and chemical roots of the disorder itself. For example, research conducted among ED samples demonstrates that there is an altered response to pain, emotion intensity, hunger and satiety, and assessment of body shape/body image. This suggests that part of the brain that senses pain related to physical and psychological experiences does not function properly (which may, in part, account for the “numbing effect that many people with eating disorders report). Hence an individual suffering from an eating disorder may be physically or psychologically compromised, but their brain does not sense this. As a result, patients can actually be quite ill but their brain (and specifically the eating disorder part of their brain chemistry) is still feeding them thoughts of “not sick enough.”

To put it plainly-You will never be sick enough, because there is no sick enough. The sick enough that the eating disorder is promising you is a disappearing goal post, a mirage. I’ve had frank conversations with the very people who my eating disorder used to compare me against- the people that I thought fit my idea of "sick enough"-and guess what? They all reiterated some version of the very same thought- “I just never saw myself as sick enough.”

This is why, when the “not sick enough” thought comes to mind, it is important to consciously process and acknowledge the fact that this is your eating disorder speaking. If you want recovery, you must challenge this thought immediately. Ask yourself, “What does sick enough mean? And why do I want to be sick? What will I get out of being sick enough? What will I achieve from being the most sick?" Challenge your eating disorder voice on this every.single.time. Do not let your ED voice bully you into thinking that being sick = happiness.

So: A quick reminder that your eating disorder is a real and valid experience even if…

You have never been underweight

You have never been inpatient

You are weight-restored

Your labs look fine

You have never been on an NG tube/never drank ensure/never been near death

You’ve been told you don’t “look like” you have an ED

You’ve never been to a therapist

You don’t have a strikingly alarming “rock bottom story” about your ED

You don’t restrict food groups/count calories

You don’t feel triggered by the media or diet culture

Your friends or family don’t know

Your friends or family don’t believe you

You like to eat certain things/look forward to meals

You don’t have fear foods

You don’t fear foods that others seem to

You don’t use the behaviors that people most commonly speak about when they discuss EDs

You don’t exercise

Your recovery is going smoothly

Your journey/gender/ethnicity/identity does not match the most common portrayal of eating disorders in the media or the memoirs

Summarily- ban/obliterate/kick out “not sick enough.” Argue relentlessly with your ED when the thought comes to mind. As a past therapist told me “Let go of the idea of not being sick enough. You are sick. You are also enough. The relationship ends there.”